On January 9, 2024, the National Medical Security Work Conference was held in Beijing. The reporter of the people's health client noted that the meeting emphasized that "adhere to the linkage of the three medicines, play an effective market and promising role, and coordinate and promote the coordinated development and governance of medical insurance, medical treatment and medicine." ”
Chen Wen, a professor at Fudan University and head of the pharmacoeconomics expert group for the adjustment of the national medical insurance drug catalogue in 2023, told the people's ** health client reporter that the adjustment of the relatively excessive medical insurance restrictions in the previous medical insurance catalogue reflects the general direction of the coordinated development and governance of medical insurance, medical treatment and medicine.
The National Conference on Medical Security was held in Beijing. The official website of the National Health Insurance Administration.
The synergy of the three medical institutions has been strengthened, and the indications of medical insurance are more respectful of clinical use.
Six days ago, on January 3, the National Health Insurance Administration also mentioned in its reply to Recommendation No. 0431 of the first session of the 14th National People's Congress that it is necessary to promote the coordinated development and governance of medical insurance, medical treatment and medicine, and proposed to coordinate and improve the basic drug system and the medical insurance drug catalog, and in the adjustment of the medical insurance catalog in 2022, the payment scope of the selected drugs and essential drugs in the national centralized procurement will be restored to the indications or functional indications of the instructions to support clinical use.
On December 13, 2023, Huang Xinyu, director of the Department of Pharmaceutical Management of the National Health Insurance Administration, also said at the press conference of the National Health Insurance Administration, "In the next step, according to the clinical drug use situation and the ability to pay for medical insurance, we will steadily promote the adjustment of the scope of medical insurance payment for drugs in the catalogue in accordance with the established ideas and plans, and hand over more drug options to clinical and medical personnel on the premise of ensuring safety and promoting the rational use of drugs." ”
At present, the national medical insurance negotiation does respect and favor clinical needs more within a reasonable range, and adjusts the relatively excessive medical insurance restrictions in the previous medical insurance catalog, so that the applicable payment scope of drugs in the medical insurance catalog is closer to the indication or functional indications of the instructions. Chen Wen told the people's ** health client reporter that this also reflects the general direction of the coordinated development and governance of medical insurance, medical care and medicine.
Medicare restrictions are reasonable, and all restrictions should not be lifted in the future.
Previously, some restrictions were imposed on the indications of medical insurance, mainly to control the abuse of drugs. Therefore, in the past environment, this measure was relatively reasonable, but with the strengthening and coordination of management in all aspects, the current use of drugs tends to be relatively rationalized, so the lifting of medical insurance restrictions is also a trend. Yu Baorong, a professor at the Health Insurance and Health Economics Research Center of the School of Insurance of the University of International Economics, also told reporters that the ideal state of drug use and medical insurance payment should be that doctors should use drugs in accordance with the guidelines, and the medical insurance indications should be as close as possible to the clinical indications.
Chen Wen pointed out that "in the near future, the phased arrangement of adjusting or restoring the payment scope of selected varieties and essential drugs in the national centralized procurement to make the medical insurance indications closer to the instructions or functional indications is good for patients and related enterprises who have been restricted from payment before, and this direction should continue." However, it should not remove all payment restrictions. ”
The current medical insurance catalogue for medical insurance indications, especially the relaxation of centralized collection of drugs and basic drugs, must be a more reasonable adjustment made by integrating various factors, and the lifting and relaxation of these restrictions in the future is a general trend, but it will also be measured by multi-dimensional factors, and the restrictions will not be completely lifted immediately. Yu Baorong also said.